| NPI | 1730721317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: TX 122142) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 122142) |
| 224Z00000X Occupational Therapy Assistant (Licence: TX 213733) | |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2022-01-05 |